Salutogenesis

Last updated July 28, 2024

Salutogenesis is the study of the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the "salutogenic model" was originally concerned with the relationship between health, stress, and coping through a study of Holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky ^[1] (1923-1994), a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, "How can this person be helped to move toward greater health?"

Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum".^[1] Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions.

Derivation

The word "salutogenesis" comes from the Latin salus (meaning health) and the Greek genesis (meaning origin). Antonovsky developed the term from his studies of "how people manage stress and stay well"^[2] (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.^{[ citation needed ]}

Development

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: "this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the 'salutogenic model'."^[2]

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalized resource deficits (GRDs). On the other hand, there are generalized resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalized resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalized resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.^[1]^[3]

Antonovsky's formulation was that the generalized resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was "in itself the essential tool for coping".^[1]

Sense of coherence

The "sense of coherence" is a theoretical formulation that provides a central explanation for the role of stress in human functioning. "Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence."^[4] Antonovsky defined Sense of Coherence as:^[2]^[5]

"a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement."^[6]

In his formulation, the sense of coherence has three components:

Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important^{[ citation needed ]}. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that "salutogenesis" depends on experiencing a strong "sense of coherence"^{[ citation needed ]}. His research demonstrated that the sense of coherence predicts positive health outcomes^{[ citation needed ]}.

During the COVID-19 pandemic, one's sense of coherence was shown to be associated with the likelihood of their adherence to the pandemic safety guidelines.^[7]

Fields of application

Health and medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioral medicine, and the sociology of health.^[2] It has been adopted as a term to describe contemporary approaches to nursing,^[8] psychiatry,^[9] integrative medicine,^[10] and healthcare architecture.^[11]^[12] The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care^[13]^[14] and for healthcare architecture.^[12]^[15]^[16]^[17]^[18] Incorporating concepts from salutogenesis can support a transition from curative to preventive medicine.^[19]

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.^[20]^[21]

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work.^[22] The meaningfulness component has also been linked with job control and task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves "the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement".^[23]

The manageability component is considered to be linked to job control as well as to access to resources.^[22] It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.^[24]

The comprehensibility component may be influenced by consistent feedback at work,^[24] for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.^[25]^[26]

Related Research Articles

Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.

Coherence is, in general, a state or situation in which all the parts or ideas fit together well so that they form a united whole.

Biopsychosocial models are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in a range of topics but mainly psychiatry, health and human development.

Behavior change, in context of public health, refers to efforts put in place to change people's personal habits and attitudes, to prevent disease. Behavior change in public health can take place at several levels and is known as social and behavior change (SBC). More and more, efforts focus on prevention of disease to save healthcare care costs. This is particularly important in low and middle income countries, where supply side health interventions have come under increased scrutiny because of the cost.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers. Also known as psychiatric oncology or psychosocial oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond medical treatment, and across the cancer trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. Founded by Jimmie Holland in 1977 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically since and is now universally recognized as an integral component of quality cancer care. Cancer centers in major academic medical centers across the country now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field.

Aaron Antonovsky was an Israeli American sociologist and academic whose work concerned the relationship between stress, health and well-being (salutogenesis).

The recovery model, recovery approach or psychological recovery is an approach to mental disorder or substance dependence that emphasizes and supports a person's potential for recovery. Recovery is generally seen in this model as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Recovery sees symptoms as a continuum of the norm rather than an aberration and rejects sane-insane dichotomy.

Within the study of human behavior, the Low Arousal Approach was developed by Professor Andrew McDonnell in the 1990s, and is now an internationally recognized model of behavior support. A low arousal approach to managing behavior of concern or challenging behavior focuses on stress and well-being, as well as how care givers respond in moments of crisis. Arousal refers to physiological arousal in response to stress, as opposed to sexual arousal. A low arousal approach to supporting individuals with additional needs aims to avoid confrontational situations and instead walk the path of least resistance.

Normalization process theory (NPT) is a sociological theory, generally used in the fields of science and technology studies (STS), implementation research, and healthcare system research. The theory deals with the adoption of technological and organizational innovations into systems, recent studies have utilized this theory in evaluating new practices in social care and education settings. It was developed out of the normalization process model.

Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, psychosocial workplace factors that affect accident risk and safety, and interventions designed to improve and/or protect worker health. Although OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, for a long time the psychology establishment, including leaders of industrial/organizational psychology, rarely dealt with occupational stress and employee health, creating a need for the emergence of OHP. OHP has also been informed by other disciplines, including occupational medicine, sociology, industrial engineering, and economics, as well as preventive medicine and public health. OHP is thus concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. The World Health Organization and the International Labour Organization estimate that exposure to long working hours causes an estimated 745,000 workers to die from ischemic heart disease and stroke in 2016, mediated by occupational stress.

Occupational stress is psychological stress related to one's job. Occupational stress refers to a chronic condition. Occupational stress can be managed by understanding what the stressful conditions at work are and taking steps to remediate those conditions. Occupational stress can occur when workers do not feel supported by supervisors or coworkers, feel as if they have little control over the work they perform, or find that their efforts on the job are incommensurate with the job's rewards. Occupational stress is a concern for both employees and employers because stressful job conditions are related to employees' emotional well-being, physical health, and job performance. The World Health Organization and the International Labour Organization conducted a study. The results showed that exposure to long working hours, operates through increased psycho-social occupational stress. It is the occupational risk factor with the largest attributable burden of disease, according to these official estimates causing an estimated 745,000 workers to die from ischemic heart disease and stroke events in 2016.

Psychological hardiness, alternatively referred to as personality hardiness or cognitive hardiness in the literature, is a personality style first introduced by Suzanne C. Kobasa in 1979. Kobasa described a pattern of personality characteristics that distinguished managers and executives who remained healthy under life stress, as compared to those who developed health problems. In the following years, the concept of hardiness was further elaborated in a book and a series of research reports by Salvatore Maddi, Kobasa and their graduate students at the University of Chicago.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

An important part of the heritage of family resilience is the concept of individual psychological resilience which originates from work with children focusing on what helped them become resilient in the face of adversity. Individual resilience emerged primarily in the field of developmental psychopathology as scholars sought to identify the characteristics of children that allowed them to function "OK" after adversity. Individual resilience gradually moved into understanding the processes associated with overcoming adversity, then into prevention and intervention and now focuses on examining how factors at multiple levels of the system and using interdisciplinary approaches promote resilience. Resilience also has origins to the field of positive psychology. The term resilience gradually changed definitions and meanings, from a personality trait to a dynamic process of families, individuals, and communities.

Spirituality affects both mental and physical health outcomes in the general United States population across different ethnic groups. Because of the nuanced definitions of spirituality and religiosity, the literature on spirituality is not consistent in definitions or measures resulting in a lack of coherence. However, taken as a whole, research tends to show that the effect of spirituality is positive, associated with better health outcomes. For those who engage in spirituality, it may serve as a buffer from negative life events, often moderating the relationship between negative life experiences and levels of anxiety or depression. The exception is when negative spiritual coping is practiced. This type of coping has negative health implications.

Job control is a person's ability to influence what happens in their work environment, in particular to influence matters that are relevant to their personal goals. Job control may include control over work tasks, control over the work pace and physical movement, control over the social and technical environment, and freedom from supervision.

The COVID-19 pandemic has impacted healthcare workers physically and psychologically. Healthcare workers are more vulnerable to COVID-19 infection than the general population due to frequent contact with infected individuals. Healthcare workers have been required to work under stressful conditions without proper protective equipment, and make difficult decisions involving ethical implications. Health and social systems across the globe are struggling to cope. The situation is especially challenging in humanitarian, fragile and low-income country contexts, where health and social systems are already weak. Services to provide sexual and reproductive health care risk being sidelined, which will lead to higher maternal mortality and morbidity.

References

1 2 3 4 Antonovsky, A. "Health, Stress and Coping" San Francisco: Jossey-Bass Publishers, 1979
1 2 3 4 Antonovsky, A. Unraveling The Mystery of Health - How People Manage Stress and Stay Well, San Francisco: Jossey-Bass Publishers, 1987
↑ Antonovsky, Aaron (1987). Unravelling the Mystery of Health. San Francisco: Jossey-Bass Inc.
↑ At everydaypsychology.com: The Sense of Coherence
↑ Antonovsky, Aaron. Studying Health vs. Studying Disease, Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 19 February 1990. available online from the Universidade Nova de Lisboa
↑ Antonovsky, Aaron (1987). Unravelling the mystery of health . Josey Bass Publishers. pp. 19. ISBN 978-1-55542-028-4.
↑ Novak, Anne Marie; Katz, Adi; Bitan, Michal; Lev-Ari, Shahar (30 June 2022). "The Association between the Sense of Coherence and the Self-Reported Adherence to Guidelines during the First Months of the COVID-19 Pandemic in Israel". International Journal of Environmental Research and Public Health. 19 (13): 8041. doi: 10.3390/ijerph19138041 . ISSN 1660-4601. PMC 9265674 . PMID 35805697.
↑ England, M., & Artinian, B. (1996). Salutogenic Psychosocial Nursing Practice. Journal of Holistic Nursing, 14(3), 147-195.
↑ Bergstein, M., Weizman, A., & Solomon, Z. (2008). Sense of Coherence Among Delusional Patients: Prediction of Remission and Risk of Relapse. Comprehensive Psychiatry, 49, 288-296.
↑ Rakel D, Fortney L. The Healing Encounter. In: Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:20-26.
↑ Dilani, A. P. D. (2008). Psychosocially supportive design: A salutogenic approach to the design of the physical environment. Design and Health Scientific Review, 1(2), 47-55.
1 2 Golembiewski, J. (2010). Start making sense; Applying a salutogenic model to architectural design for psychiatric care. Facilities, 28(3).
↑ Golembiewski, J. (2009). Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision. Paper presented at the Australian Rural and Remote Mental Health Symposium.
↑ Golembiewski, J A (June 2012). "Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision". The Australian Journal of Emergency Management. 27 (2): 42–47.
↑ Golembiewski, J A (5 March 2010). "Start making sense; Applying a salutogenic model to architectural design for psychiatric care". Facilities. 28 (3/4): 100–117. doi:10.1108/02632771011023096.
↑ Golembiewski, Jan A (April 2012). "Psychiatric design: Using a salutogenic model for the development and management of mental health facilities". World Health Design Scientific Review. 5 (2): 74–79.
↑ Golembiewski, Jan A (2012). "Salutogenic design: The neural basis for health promoting environments". World Health Design Scientific Review. 5 (4): 62–68.
↑ Miedema, Elke; Lindahl, Göran; Elf, Marie (2019). "Conceptualizing health promotion in relation to outpatient healthcare building design: a Scoping review". HERD. 12 (1): 69–86. doi: 10.1177/1937586718796651 . ISSN 1937-5867. PMID 30203663.
↑ Bhattacharya, Sudip; Pradhan, KeertiBhusan; Bashar, MdAbu; Tripathi, Shailesh; Thiyagarajan, Arulmani; Srivastava, Abhay; Singh, Amarjeet (2020). "Salutogenesis: A bona fide guide towards health preservation". Journal of Family Medicine and Primary Care. 9 (1): 16–19. doi: 10.4103/jfmpc.jfmpc_260_19 . ISSN 2249-4863. PMC 7014834 . PMID 32110558.
↑ Gregor J. Jenny, Georg F. Bauer, Hege Forbech Vinje, Katharina Vogt, Steffen Torp, The Application of Salutogenesis to Work. In: The Handbook of Salutogenesis, 3 September 2016, pp. 197-210. DOI 10.1007/978-3-319-04600-6_20.
↑ Piotrowicz M, Cianciara D (2011). "[Salutogenesis--new approach to health and disease]". Przeglad Epidemiologiczny (in Polish). 65 (3): 521–7. PMID 22184959.
1 2 U. Lindmark, P. Wagman, C. Wåhlin, B. Rolander (9 November 2016). "Workplace health in dental care – a salutogenic approach". International Journal of Dental Hygiene. 16 (1): 103–113. doi:10.1111/idh.12257. PMC 5811775 . PMID 27860378.{{cite journal}}: CS1 maint: multiple names: authors list (link)
↑ Georg F. Bauer; Gregor J. Jenny (1 July 2013). Salutogenic organizations and change: The concepts behind organizational health intervention research. Springer Science & Business Media. p. 81. ISBN 978-94-007-6470-5.
1 2 Georg F. Bauer; Gregor J. Jenny (1 July 2013). Salutogenic organizations and change: The concepts behind organizational health intervention research. Springer Science & Business Media. p. 82. ISBN 978-94-007-6470-5.
↑ Forooraghi, Melina; Miedema, Elke; Ryd, Nina; Wallbaum, Holger (18 March 2020). "Scoping review of health in office design approaches". Journal of Corporate Real Estate. 22 (2): 155–180. doi:10.1108/JCRE-08-2019-0036. ISSN 1463-001X. S2CID 216201188.
↑ Forooraghi, Melina (2020). Health and Office Architecture (Thesis). Chalmers University of Technology.